Presentations at Windsor 2016 AFMS-AMFB Annual Conference
Here are a few lines demonstrating the wide range of subjects, and excellence of presentations at our 2016 conference held in Windsor. The setting, hotel and arrangements were quite splendid, and our very varied speakers outstanding.
We started with a talk from Julia DINA from Caen, on an outbreak of mumps in English winter sports enthusiasts, which led on to a description of the general impact of mumps, including orchitis, oophoritis, pancreatitis and temporary mild renal function abnormalities in 30-60% of cases. Then Julia described the different genotypes of which there are 12 recognised. MMR (ROR) is based on Type A and the majority of cases are of Type G which may be drifting, making the vaccine less effective. Other outbreaks have followed a similar course recently, but research has shown that the severity of side effects is reduced by vaccination, although virus shedding in saliva is not reduced.
Tim REILLY presented a troubling case of intractable diarrhoea with severe weight loss which came on after a holiday visit to Florida. It is safe to say that no one in the audience recognised the diagnosis of amyloidosis in a patient with cardiomyopathy, peripheral neuropathy and bowel symptoms. Tim showed excellent slides of full-thickness biopsies of bowel demonstrating the amyloid. Sadly, there has not been a great improvement in the patient’s condition following the definitive diagnosis. We were informed about the very varied presentations of amyloid disease and the 2 main types: hereditary or post inflammatory disease. Treatment remains difficult although some cases respond to low dose treatment similar to myeloma therapy.
Claire DELVAL talked about Lyme disease and the controversies over the existence or not of chronic Lyme. Most of us were unaware that infected ticks (tiques) can carry multiple different Borrelia viruses as well as multiple other pathogens, and that B burgdorferi is uncommon in Europe, with fewer than 20% of cases. ELISA tests are based on B burgdorferi as it is the main culprit in the USA. There is a huge variation in reported rates of Lyme across Europe as it is not notifiable in most countries, and testing is of poor specificity and sensitivity so confirmation is quite difficult. New tests (ELISPOT) are being produced, at higher cost but greater sensitivity, and seem to demonstrate that there is indeed a chronic condition, but this is still under investigation.
Michel BISMUTH presented a review of a survey of primary enuresis done in his department. This was for a thesis, but did not have great predictive value as the responding families were not demographically comparable with the local population and the test numbers were small. Nevertheless it was a useful review of the natural history of spontaneous recovery (15% per annum), and of the sometimes marked social consequences for the families. Part of the survey was on paper, part via the website www.pipiaulit.com.
Mike KELLY gave one of his excellent reviews of the differences in medico-legal procedures between our countries. In a case where damages are being sought in the UK, the majority are settled long before an appearance in court, largely due to informed but disinterested medical experts having detailed in camera debates about which items can be agreed and which remain contentious. The content of this debate, but not its outcome, remains confidential. The stages of the process are too numerous to precis here, but the importance of the experts being fully informed and prepared prior to the meeting, and even more so if there were to be a court hearing were emphasised. Anyone wishing more information can request it from the Society or directly from Mike.
Corinne MATUSSIERE is an A&E specialist and, as in UK, her service is under increasing pressure. She gave a thoughtful overview of burnout in professionals, concentrating on her own department where a questionnaire has demonstrated high scores in a validated burnout tool. She suggested that an annual application of such a questionnaire might prevent events like the suicide of a cardiologist whose close colleagues had not either noted or responded to his mental state. There has been a lot of work done on measuring “stress hormones’ but the results have been unhelpful so far with too many confounding reasons for the measured changes. A work in progress which might bear fruit on a difficult area of our lives.
John ALTRIP is in the process of developing a totally new way of assessing the state of health of sufferers of (cardio-)respiratory disease. A chip that measures CO2 and O2 concentrations in real time has been introduced into a simple device allowing normal tidal breathing to be used by the patient rather than peak flow etc. The graphs obtained after training in the tool show clear differences across the respiratory cycle including in some cases marked changes in profile prior to and exacerbation of COPD, for example, potentially allowing early treatment at home and obviating admission. The predicted savings in ill health and in cost to the health service are large, and John is presently hoping to take the device to market for home use once a commercial sponsor is found.
We then had the annual wonderful problem of trying to separate excellent student presentations from each other. It gets harder every year.
Kathleen JOSEPH gave a talk on the chaotic life of a patient she was involved with in the Wiltshire Drug and Alcohol Service.
Marianne PHILLIPS told us about Zika virus infections in Guadeloupe and the difficulties in a condition with vector, sexual and vertical spread.
Sophie L’EBRALY showed her professional curiosity and nous in diagnosing a troublesome case of abdominal pain. She offered the diagnosis of Mediterranean Familial Fever which turned out to be correct, but had not been suspected by the paediatricians and surgeons who had previously performed an excision of a normal appendix. Treatment options are few but colchicine apparently is often effective in relieving symptoms, to the surprise of many in the audience.
Houda DRIF, on behalf of her small group, gave a most interesting report on maternal HIV/AIDS in Sub-Saharan Africa, showing that many of us were not totally confident in the details of when mother-child transmission is most likely (during delivery) or in treatment regimens around the time of pregnancy and the puerperium.
Clara FARQUE has been instrumental in setting up a student AFMS, initially in Warwick as a result of Zara’s Medical French course. It is very encouraging that this is starting up, and it does seem to have a format that is attractive to students in Warwick but is also transferable to other medical schools. A student Facebook page for AFMS will be an important vector.
Christian DORADO CORTEZ gave a very enthusiastic and knowledgable account of non-verbal communication and its great relevance to doctor-patient contacts.
The annual James Tudor Lecture was given by:
Professor Julian F.R. Paton PhD
Professor of Translational Cardiovascular Science
School of Physiology, Pharmacology & Neuroscience, University of Bristol
and titled “High blood pressure: getting to the bottom of it.”
A very brief extract of a fascinating and important presentation follows.
Hypertension is the leading cause of mortality in the world. ~40% of over 1 billion affected patients on medication are not controlled to target levels. This unmet need demands new approaches to better understand and control blood pressure.
New information and challenges include:
(i) A correlation exists between hypertension and high cerebrovascular resistance, due to vertebral artery hypoplasia, and absence of posterior communicating arteries. How do we improve brain blood flow and lower blood pressure in hypertensive patients with high cerebral vascular resistance without causing ischaemia.?
(ii) The carotid bodies are hyperactive in animals and ~55% of patients with hypertension. Experimental excision of this organ (unilaterally) showed it to be a clinical target for control of blood pressure in drug resistant hypertensive patients. A new drug (a purinergic P2X3 receptor antagonist has proven effective at lowering blood pressure in both rodent and ovine models of hypertension. The drug (so called AF-130, Merck) awaits a clinical trial in human hypertensive patients that have hyperactive carotid bodies.
Helen MACKAY gave a most interesting talk on the Scottish Women’s Hospital at Royaumont. It was started by Frances Ivens, the first registered female surgeon (1907) and Elsie Inglis, most famous female doctor to come out of Edinburgh. Both were suffragists, (as distinct from Suffragettes), and refused to allow the War Office from allowing them to open their hospital behind the lines. Moneyed ladies took their cars to be converted to ambulances; men had to be maintained on the staff as women were not allowed to drive in France (but they did). Unsatisfactory inspections of the hospital in what was really an abandoned and very decrepit abbey meant a delay, but they refused to give up and by the Battle of the Somme were a fully-functioning front-line surgical unit with excellent results, largely because of developments in debridement and wound hygiene, plus anti-serum, to reduce the risks of gas gangrene. Ivens’ publications (under the name of a male colleague, of course) remain the mainstay of battlefield surgery today.
Linda PARR gave a talk on the complicated family of the Tudors, concentrating on the women, their influences on the dynasty and the dreadful obstetric histories that could not be improved over those of the lowest orders. Despite the carnage of maternity, and in the case of 2 of Henry VIII’s wives the axe, the Tudor royal women on average lived longer than the men. Elizabeth might have chosen to be celibate to avoid following her royal family to an early grave, but at the expense of the Stuarts taking over.
J-P BOYES told us of their efforts to give adequate training in chronic disease management to medical students. They have tapped into the resources in private practice, so away from the medical school. Most chronic disease never makes it to the tertiary centre, so this makes good sense and has been welcomed by the students. Their only negative comments were around the formal presentations in the medical school itself; the experience outside was thoroughly embraced.
Flavia LESLIE and Andrew McAULAY taught psychiatry at Decartes University in Paris. 400 students a week are getting excellent medical English, but this external input has been welcomed universally. One of the visits coincided with terrorist attacks on Paris. The visitors recognised the deep shock through the student (and staff) body and modified their presentations to concentrate on PTSD, using a BBC film and role play. This appears to have been powerful, educational and therapeutic.